Evoke change talk to enhance motivation for change
Previously, we looked at Motivational Interviewing (MI) as having four key processes and reviewed practice exercises targeting the first two processes: engaging and focusing. This week’s intentional practice centers on evoking, specifically on evoking change talk.
Once we have engaged with our client and have collaboratively identified a goal (focusing), ambivalence about change is still common. Increased client change talk is associated with increased likelihood for change. Evoking change talk is key. When ambivalence is present, it is normal for change talk to occur within the context of sustain talk. This activity will help you practice selectively reflecting the change talk content contained within ambivalence.
Instructions: Review the client statements below, containing both change talk and sustain talk, and develop reflective statements that are focused on the change talk.
Here’s a pre-test to get you started:
“I am 78 years old, and this medication is ruining what life and pleasure I have left. I know the doctor said there is a good chance it will help things, but I just don’t think these side effects are worth it.”
Sample therapist responses: Which reflective response focuses on the change talk in the above statement?
a. You really don’t want to continue with this medication.
b. It’s pretty clear that the doctor wants you to continue.
c. You’re not sure whether it’s worthwhile to continue the medication.
(check out the end of this article for the correct answer)
Note: The point of this exercise is not to do a double-sided reflection, but rather to listen for and select the change talk, and make that your focus in your reflective statement.
|Client Statement: Start out by underlining the change talk in the statements below
|Reflection: Now write down a reflection that selectively responds only to the client change talk contained in the statement|
|1. The material the clinic gave me for my high blood pressure said I should avoid processed food, or else read the labels. I’m so busy I barely have time to eat, let alone shop, analyze my groceries, and spend half the night in the kitchen. These people do not live in the real world.
|2. Is it such a crime that I want to enjoy life while I’m still young? Once I’m tied into work, paying the bills, kids and all that I can scale things back.
|3. It is so frustrating that the minute you get pregnant everyone expects you to be perfect! I am so stressed out, it can’t be good for the baby. I am only having a few cigarettes a day, and my partner is totally on my case about it.
Reflective practice questions:
- How easy or difficult was it for you to identify the change talk in each of the client statements?
- How easy or difficult was it for you to frame a complex reflection that would further evoke change talk?
- What are the implications of this for your own continued growth and practice as a Motivational Interviewing practitioner?
(Correct answer: b. It’s pretty clear that the doctor wants you to continue.)